Hospital-Associated Multicenter Outbreak of Emerging Fungus <i>Candida auris</i>, Colombia, 2016

Armstrong, Paige A.; Rivera, Sandra; Escandón, Patricia; Cáceres, Diego H.; Chow, Nancy A.; Stuckey, Matthew J.; Díaz, Jorge; Gómez, Adriana Morales; Vélez, Nórida; Espinosa-Bode, Andrés; Salcedo, Soraya; Marín, Adriana; Berrío, Indira; Varón, Carmen; Guzman, Angel; Pérez-Franco, Jairo E; Escobar, Julian D; Villalobos, Nohora; Correa, Juan M; Litvintseva, Anastasia P.; Lockhart, Shawn R.; Fagan, Ryan; Chiller, Tom; Jackson, Brendan R; Pacheco, Óscar

doi:10.3201/eid2507.180491

Cited by 68 publications

(71 citation statements)

References 19 publications

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“…Reliance on traditional methods may lead to misidentification. Candida auris is usually resistant to fluconazole [4] and has been associated with resistance to multiple antifungal drug classes including echinocandins and amphotericin B [5]. The case fatality of bloodstream infections with C. auris has been reported to be up to 60% and the infections may be difficult to treat because of resistance to multiple antifungal agents [2,6].…”

Section: Discussionmentioning

confidence: 99%

Candida auris: epidemiological situation, laboratory capacity and preparedness in the European Union and European Economic Area*, January 2018 to May 2019

et al. 2020

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Between January 2018 and May 2019, 349 cases of Candida auris were reported in the European Union/European Economic Area*, 257 (73.6%) colonisations, 84 (24.1%) bloodstream infections, seven (2.0%) other infections and one case of unknown infection/colonisation status (0.3%). Most cases (97.1%, n = 339) were reported from Spain or the United Kingdom, but also for the first time in Greece, the Netherlands and Poland. Laboratory capacity and preparedness has improved since January 2018.

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Section: Discussionmentioning

confidence: 99%

Candida auris: epidemiological situation, laboratory capacity and preparedness in the European Union and European Economic Area*, January 2018 to May 2019

et al. 2020

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“…In the last decade, Candida auris has emerged in healthcare settings as a multidrug-resistant organism in over 30 countries worldwide (1). Primarily a skin colonizer, this pathogenic yeast can cause bloodstream infections and other infections (2), is often resistant to multiple classes of antifungal drugs (3, 4), and can spread via nosocomial transmission causing outbreaks of invasive infections (5–12).…”

Section: Introductionmentioning

confidence: 99%

Tracing the evolutionary history and global expansion ofCandida aurisusing population genomic analyses

Chow

Muñoz

Gade

et al. 2020

Preprint

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AbstractCandida auris has emerged globally as a multidrug-resistant yeast that can spread via nosocomial transmission. An initial phylogenetic study of isolates from Japan, India, Pakistan, South Africa, and Venezuela revealed four populations (Clades I, II, III, and IV) corresponding to these geographic regions. Since this description, C. auris has been reported in over 30 additional countries. To trace this global emergence, we compared the genomes of 304 C. auris isolates from 19 countries on six continents. We found that four predominant clades persist across wide geographic locations. We observed phylogeographic mixing in most clades; Clade IV, with isolates mainly from South America, demonstrated the strongest phylogeographic substructure. C. auris isolates from two clades with opposite mating types were detected contemporaneously in a single healthcare facility in Kenya. We estimated a Bayesian molecular clock phylogeny and dated the origin of each clade within the last 339 years; outbreak-causing clusters from Clades I, III, and IV originated 34-35 years ago. We observed high rates of antifungal resistance in Clade I, including four isolates resistant to all three major classes of antifungals. Mutations that contribute to resistance varied between the clades, with Y132F in ERG11 as the most widespread mutation associated with azole resistance and S639P in FKS1 for echinocandin resistance. Copy number variants in ERG11 predominantly appeared in Clade III and were associated with fluconazole resistance. These results provide a global context for the phylogeography, population structure, and mechanisms associated with antifungal resistance in C. auris.ImportanceIn less than a decade, C. auris has emerged in healthcare settings worldwide; this species is capable of colonizing skin and causing outbreaks of invasive candidiasis. In contrast to other Candida species, C. auris is unique in its ability to spread via nosocomial transmission and its high rates of drug resistance. As part of the public health response, whole-genome sequencing has played a major role in characterizing transmission dynamics and detecting new C. auris introductions. Through a global collaboration, we assessed genome evolution of isolates of C. auris from 19 countries. Here, we described estimated timing of the expansion of each C. auris clade and of fluconazole resistance, characterized discrete phylogeographic population structure of each clade, and compared genome data to sensitivity measurements to describe how antifungal resistance mechanisms vary across the population. These efforts are critical for a sustained, robust public health response that effectively utilizes molecular epidemiology.

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“…An important objective of this EQA was to raise awareness about the potential misidentification of C. auris and its ability to cause nosocomial outbreaks, as early recognition is pivotal to limit the unrecognized spread of C. auris in the hospital environment [3,9,31,32]. As similar to the results of a laboratory survey in Belgium that was conducted during the same period, the results of this EQA indicated that not all laboratories were aware of the potential risks of C. auris, nor of the limitations of their yeast identification protocols [28].…”

Section: Discussionmentioning

confidence: 99%

“…Another study used the Bruker MALDI Biotyper to identify isolates belonging to the African clade III [46]. Isolates form the South American clade IV were reported to be correctly identified with the Bruker MALDI Biotyper [3,47]. However, as it was not the objective to evaluate the performance of the MALDI-TOF MS during the latter three studies, no reference methods for the identification were used, and it is not known how many isolates were misidentified.…”

Section: Discussionmentioning

confidence: 99%

“…Candida auris is an ascomycete yeast that is causing nosocomial outbreaks in healthcare settings around the world [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. The yeast is an emerging pathogen and is considered a serious global health threat, due to its common multidrug-resistant phenotype and ability to cause outbreaks in health care settings [18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

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External Quality Assessment Evaluating the Ability of Dutch Clinical Microbiological Laboratories to Identify Candida auris

Buil

Lee

Curfs-Breuker

et al. 2019

JoF

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Background: Candida auris is a yeast that is causing nosocomial outbreaks in healthcare facilities around the world. There is a risk of the misidentification of C. auris with matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS)—when libraries are used that lack C. auris spectra, or when conventional biochemical methods are used. Methods: We conducted an external quality assessment to evaluate the ability of Dutch clinical microbiological laboratories to identify C. auris, and to raise awareness about the risk of misidentification. Results: 35/47 participating laboratories were able to identify C. auris correctly. Only 2/14 labs that potentially misidentified C. auris with their primary identification methods specified that they would perform additional tests to exclude C. auris when appropriate. 45/47 labs used MALDI-TOF MS systems to identify Candida species. Conclusions: There was a lack of awareness about the potential misidentification of C. auris in many labs that used MALDI-TOF MS with libraries that lacked C. auris spectra, and labs that used Vitek 2. However, as the currently available MALDI-TOF MS libraries in The Netherlands contain several C. auris spectra, we expect that currently almost all participating laboratories are able to identify C. auris correctly, as 45/47 participating laboratories use MALDI-TOF MS as their primary yeast identification method.

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Hospital-Associated Multicenter Outbreak of Emerging Fungus Candida auris, Colombia, 2016

Abstract: Adherence to infection control recommendations is critical to prevent spread of this novel yeast.

Cited by 68 publications

References 19 publications

Candida auris: epidemiological situation, laboratory capacity and preparedness in the European Union and European Economic Area*, January 2018 to May 2019

Candida auris: epidemiological situation, laboratory capacity and preparedness in the European Union and European Economic Area*, January 2018 to May 2019

Tracing the evolutionary history and global expansion ofCandida aurisusing population genomic analyses

External Quality Assessment Evaluating the Ability of Dutch Clinical Microbiological Laboratories to Identify Candida auris

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